Individual
AISHA SOPHIA MADRONE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LAC.
Contact information
Practice address
436 SE 12TH AVE, PORTLAND, OR 97214-1323
(503) 236-6833
Mailing address
436 SE 12TH AVE, PORTLAND, OR 97214-1323
(503) 236-6833
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
AC01200
OR
Other
Enumeration date
01/23/2018
Last updated
01/23/2018
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